Provider Demographics
NPI:1538528922
Name:NORTH VALLEY CENTER FOR ORAL AND IMPLANT SURGERY
Entity type:Organization
Organization Name:NORTH VALLEY CENTER FOR ORAL AND IMPLANT SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGERY ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:S
Authorized Official - Last Name:STANSBURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-978-2890
Mailing Address - Street 1:4025 W BELL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-2750
Mailing Address - Country:US
Mailing Address - Phone:602-978-2890
Mailing Address - Fax:602-978-5794
Practice Address - Street 1:4025 W BELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-2750
Practice Address - Country:US
Practice Address - Phone:602-978-2890
Practice Address - Fax:602-978-5794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes126800000XDental ProvidersDental AssistantGroup - Single Specialty